Automatic Self-Administered 24-hour Dietary Recall (ASA24)

NIH-AARP Comprehensive Lifestyle Interview by Computer (CLIC) Study (NCI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0594 can be found here:

Documents and Forms

Document Name Document Type
Form 4-1B Automatic Self-Administered 24-hour Dietary Recall (ASA24) Form
Att 4-1A_ASA24BurdenPage.pdf 72.51.43.13/asa24/ Instruction
4-1B ASA24 instrument Att 4-1B_ Instrument ASA24.pdf asa24test.westat.com Form

Information Collection (IC) Details

IC Title:	Automatic Self-Administered 24-hour Dietary Recall (ASA24)	Agency IC Tracking Number:

Is this a Common Form? Yes		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	4-1B	ASA24 instrument	Att 4-1B_ Instrument ASA24.pdf	http://asa24test.westat.com	Yes	Yes	Fillable Fileable
Instruction			Att 4-1A_ASA24BurdenPage.pdf	http://72.51.43.13/asa24/	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,036	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,760	1,760
Annual IC Time Burden (Hours)	880	880
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.